Consider the many parallels between the treatments advocated by those who claim being gay is a disease, and those being pushed by our public health establishment to “cure” fat children and adults of their supposedly pathological state.

The advocates of so-called conversion or reparative therapy believe that “homosexuality” is a curable condition, and that a key to successful treatment is that patients must want to be cured, which is to say they consider same-sex sexual orientation volitional. These beliefs mirror precisely those of the obesity establishment, which claims to offer the means by which fat people who want to choose to stop being fat can successfully make that choice.

Those who seek to cure homosexuality and obesity have tended to react to the failure of their attempts by demanding ever more radical interventions. For example, in the 1950s Edmund Bergler, the most influential psychoanalytical theorist of homosexuality of his era, bullied and berated his clients, violated patient confidentiality and renounced his earlier, more tolerant attitude toward gay people as a form of enabling. Meanwhile, earlier this year a Harvard biology professor declared in a public lecture that Mrs. Obama’s call for voluntary lifestyle changes on the part of the obese constituted an insufficient response to the supposed public health calamity overwhelming the nation, and that the government should legally require fat people to exercise.

My first thought was, is this for real? You have to read the whole thing. I can’t but help wonder if some of the same issues that cropped up during our recent Down syndrome discussion isn’t reflected in this sort of thing. The author is Paul Campos, a law professor and gadfly, who himself is not overweight from what I can tell. It seems that as a society we now have a difficulty acknowledging that state A is preferable to state B, without that acknowledgment being assumed to be a license to strip all dignity from those who are in state B.

I have to be honest and admit that I think there’s some bias in the attitudes you see such as the ones that the Harvard professor above expressed. A few years back Sydney Brenner said some really strange things about overweight people, including specific overweight people in the room! Obesity has a negative economic correlation in the West, and is strongly stratified by class. For whatever reason fat people are not yet a class toward which sensitivity is warranted. And so boorish behavior is not uncommon.

Because honest differences in human quality are not acknowledged we have to remain silent. Beauty and intelligence are social constructs. And now you have the strangeness of people seemingly claim that some people are just born fat, and if they are born fat there is no way that they should be judged to be any less than someone who is of normal size. The very use of the term normal privileges a particular somatotype as normative. The default. The ideal. And I’m fine with that. I think we’d be healthier as a society if we could learn to talk about these issues, rather than get boxed into being card-carrying members of NAAFA or fat-nazis. Similarly I think being heteronormative is fine. Most people are heterosexual, and will be for the foreseeable future. This may change in the future, but we don’t live in the future. We live in the now.

I’ve run into this attitude about obesity before. The above piece is definitely a rather hilarious example of it though. It seems like you could make the same comparison to other diseases, like cancer. A doctor could tell his/her cancer patients that they have to want to be treated/cured. They have to want to be cancer-free, or else, if they don’t actively seek treatment, they’ll, you know, die. The fact that you need to want to be cured doesn’t suggest that you don’t actually have a disease… You could even legitimately stretch it to the second paragraph you quoted, and say in some cases voluntary decisions are not adequate when it comes to children, such as with parents who do not wish to have their child medically treated for terminal cancer because they prefer faith healing. You could argue that the government should intrude to force treatment on that child. That’s something that is actually being argued in our public sphere, and from what I’ve seen, seems to be accepted on face-value in liberal circles, although I’ve never seen any survey data. (I’m not actually sympathetic with the view that obesity treatment should be legally enforced, at least on adults. Despite the fact that people generally don’t recognize child autonomy, I have a hard time seeing parents being okay with the government decided the diet/exercise habits of their children. But maybe that will change?).

I think people that have this attitude that obesity is in no way a bad thing are either not familiar with the health consequences of obesity and/or not familiar with obesity demographics over the past few decades. Every time I see a map of the US color-coded by BMI over time, I’m simply flabbergasted over the massive change that has occurred in such a short time (this is a good example: http://en.wikipedia.org/wiki/File:Obesity_state_level_estimates_1985-2010.gif). While the rates of biological homosexuality have probably remained relatively stable in our population over the last few hundred or thousand years (assuming homosexuality is due to genetics or abnormal fetal developmental due to environmental influences from non-external [as in, not outside the mother] sources), rates of obesity have skyrocketed in just the last few years. Most cases of obesity are not ‘natural.’ There has surely always been a background rate of obesity due to non-diet/exercise related factors, but surely no one could actually think that there has been a huge genetic shift in the last few years that has lead to current obesity rates. This is an environmental cataclysm that we ourselves have sown, and thus, it seems obvious that it’s something we should be concerned about.

On the other hand, I definitely think we should be sensitive to those who are overweight, and I don’t think being mean or discriminatory is going to help their plight. Losing weight isn’t easy, and depression due to social rejection isn’t going to be a very good motivator. But this is kind of a no-brainer, right?

https://plus.google.com/109962494182694679780/posts Razib Khan

who is this “they” you speak of? overweight people are not a minority and the obese are now on the order of 1 out of 4.

http://ivorgoodbody.com Ivor Goodbody

Razib, As I previously tweeted to you, Campos is trying to bamboozle folks with this piece.

He seriously misrepresents his sources and his case falls to pieces on examination of the medical evidence.

I’m assuming you’re referring to my last statement. I didn’t realized that I said overweight instead of obese. The majority isn’t likely to discriminate against themselves, right?

I think that point undermines, even further, Campos’ argument that the obese share a similar plight to gays (and I assume that’s what you were hinting in your response). The majority of our overweight population probably isn’t being very discriminatory to the obese among us, and if anything, this country seems to be becoming friendlier and friendlier to obese people, at least from what I’ve seen. But then again, maybe that’s not how obese people feel. I don’t know.

http://forwhattheywereweare.blogspot.com/ Maju

I don’t think your comparison is correct: gayness is either a biological state or a free choice or a combination of both. And for most people affected it is a good thing, hence the term “gay”, which used to mean happy.

Instead fatness is almost invariably a bad thing and never a free choice. You may choose to eat too much or to exercise too little but you do not choose to be fat. And once you’re fat you find harder to exercise, partly because other people look at you with disdain and mockery. So it is a vicious circle.

The government could overtax unhealthy foods or forbid cars or build parks and sports facilities or give each citizen a little orchard where to work and grow their own veggies… but you can’t force people to exercise. Besides, it’s not clear if exercise alone would be of any use or in what term: the reasons behind overweight and obesity are complex and excess availability of calory-rich food is probably more important than mere exercise, at least that’s what a recent study comparing three different populations with radically different lifestyles suggested.

In a sense, we can say that obesity is the byproduct of economy success. This one is measured by GDP and this one is essentially consumption: so the more we consume, the greater the GDP – and that makes us fat for excess of food and excess of cars.

MDF, MD

I do not condone a dismissive or abusive attitude toward anyone, and I generally think that the government should take a hands off attitude towards most things.

I feel rather ambivalent about this, but the line of thought I have been considering is:

If a large segment of the population undertakes certain behaviors (such as overeating and not excersizing) that busts the government’s health care budget, and they persist in those behaviors despite years of education, begging, and pleading, should not the government take some action to stop those behaviors?

I am not going to pretend to have the answer to that question or to know what that action might be. It’s just something to consider.

http://mikethemadbiologist.com Mike the Mad Biologist

It is interesting to note that in the 1930s-1950s, there were ads to help women from being too *thin*. Leaving aside the health issues, it’s an interesting shift. Seems to tie in, as you note, to economic class.

With both obesity and homosexuality, I think that most people on the left are willing to shelve their de facto Blank Slatism and admit non-socially constructed causes. Why these two traits, but not others? I have no idea.

http://lablemming.blogspot.com/ Lab Lemming

#6:
Awesome link.

Karl Zimmerman

8 –

Gender identify leftism is even funnier in this respect. I think that the PC thing to say now is that trans people knew they felt different from their biological gender from a very small age, and they were “inherently” attracted to opposite-gender activities as a child. If you accept this as true, you must also accept the converse is true for at least some people – that the normative association of biological with “mental” gender, along with the attraction of boy/girl children to stereotypical boy/girl behavior, is also inherent.

I think Razib hit the nail on the head here in the OP. Identity leftism in the west can be boiled down, more or less, as opposition to anything seen as normative or traditionally desirable – whiteness, maleness, straightness, and middle-class identity first and foremost, but more broadly things like nuclear families, monogamy, thinness, lack of disability, probably even tallness. I think even the “aggravated aspie” movement online can be traced to the same place, as it’s essentially people who are asking not to be judged as social retards because they were “born that way.”

Regardless, the logic is simple. Before considering the possibility of inherent difference, one asks if admitting it’s there will cut against traditional stereotypes, or reinforce them. If the former, it is embraced, if the latter, it is discarded.

In general, I agree that on utilitarian grounds, normative arguments make sense, as while the majority clearly doesn’t fall under all normative stereotypes, all fall under some, and it doesn’t make sense to cater society to the eccentrics (and I say this as an eccentric myself). That said, I’m not sure that the modern rise of “tolerance” has really made American culture nonconformist enough to hurt “the normals,” even when it gets particularly ridiculous. A highly conformist society can provide a lot of mental anguish (at the very least) to those who are different, and provides somewhat dubious benefit to those who aren’t.

Anthony

I saw a talk given by Jennifer Michael Hecht where she asserted that our society has an obsession with exercise symptomatic of our militaristic culture which likens us to the Romans and the Nazis. Wtf????

Sandgroper

What does she have against Romans?

ackbark

@1. Looking at that gif at Wikipedia it looks like Indiana/Kentucky and Louisiana/Mississippi are the epicenters of fatness.

@12. She’s probably fat.

Schrödinger’s Hat

@5 You said, “Instead fatness is almost invariably a bad thing and never a free choice,” which I take to mean ‘people cannot choose to not be fat.’ It’s trivial to find counterexamples to this.

Also considering the amount of press the subject has gotten lately, you’d have to think that most people are really dumb or willfully ignoring the role that diet & exercise play in being fat.

Dan H

“Being fat is like being gay”

I think you’ve convinced me to drop those pounds I’ve been meaning to lose!

Sandgroper

@13 – Visual confirmation obtained.

My understanding is that Louisiana is the obesity epicentre, but I don’t remember how I know that.

“Jennifer suggests that humanists are too often tied to science and that the arts might be a better way of understanding our place in nature.” Oookay.

chris w

Have the people who write such articles never visited Europe before? There’s a whole continent full of people who aren’t very different genetically from American whites but who have a significantly lower incidence of obesity.

The people who claim that being gay is a choice are not the same group of people who claim that being fat is a result of certain choices. However, the people pushing for fat acceptance ARE the same group of people who often argue that the U.S. should be more like Europe, apparently without meaning that we should be more like Europe by being less fat.

By state, obesity prevalence ranged from 20.7% in Colorado to 34.9% in Mississippi in 2011.

No state had a prevalence of obesity less than 20%. 39 states had a prevalence of 25% or more; 12 of these states had a prevalence of 30% or more: Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Texas, and West Virginia.

“The South had the highest prevalence of obesity (29.5%), followed by the Midwest (29.0%), the Northeast (25.3%) and the West (24.3%).”

Wishing you lifelong health, naturally

Ivor

http://www.textonthebeach.com Seth

If all folks on the Left were as level-headed about these things as Karl Zimmerman, I never would have drifted from the Left . . .

ackbark

I know I don’t get out much anymore, but I’ve never heard anyone ‘pushing fat acceptance’.

BDoyle

The tone of Paul Campos’ lecture makes it clear why many overweight people want to see a biological cause for their problem that is beyond their control. That would help deflect any accusations that they are somehow morally inferior or more sinful than skinny people. Same goes for homosexuals searching for an adaptive explanation for their preference. (We won’t mention any names.) They better be careful about this, though. Being obviously “born that way” has not prevented racial groups from being regarded as morally inferior by some others.

Luke Raines

I think an argument could be made for saying that both obesity and homosexuality are harmful since they can interfere with an individual’s ability to pass on their genes to the next generation. Of course, in some societies, obesity in women is viewed as attractive. Therefore while homosexuality likely interferes with a person’s ability to reproduce in most societies, the situation is different for female obesity.

Sandgroper

@20 – Yeah. In Oz admittedly it has been in response to a lot of doctors talking to the press about the problems associated with treating obese people, the rapidly growing burden on the health care system, increased risks of surgery, the ‘obesity epidemic’, how the hospitals should deny them treatment unless they ‘lose weight’, etc.

When my daughter was in Human Biology lab, she said all the students dreaded getting an obese cadaver to work on, because everything was so much more difficult. I’ve heard medical students say the same thing, and surgeons saying they hate getting obese patients.

The ‘fat power’ or ‘fat rights’ groups treat these kinds of reactions as a discrimination issue, or do the DS thing and claim that being fat is not a ‘bad’ condition, but there are very real practical difficulties associated with it, aside from the increase in diseases associated with obesity.

I’m singing to the choir, obviously, but my daughter gave me a detailed description of the difficulty of dissecting an obese cadaver (over dinner, which is her usual thing), and it’s orders of magnitude more difficult than working with a ‘normal’ corpse.

It really is worrying that now >25% of the population in the USA and Australia are in that category, and representing it as an ‘acceptance’ issue is really delusional.

https://plus.google.com/109962494182694679780/posts Razib Khan

I think an argument could be made for saying that both obesity and homosexuality are harmful since they can interfere with an individual’s ability to pass on their genes to the next generation.

being educated or smart also seems to interfere with passing genes. you can look it up in the GSS.

obesity in women is viewed as attractive.

is it really obesity? i know this is often claimed, but i’m moderately skeptical. in many poor societies plumpness is preferred. but obesity is considered kind of weird, at least in the young.

https://plus.google.com/109962494182694679780/posts Razib Khan

a note: if you leave a long snarky comment which stuffs words into my mouth, it won’t get published, and you will be banned. i am putting this up as a public service announcement, because several people have left really long comments of just that form. if you want to privately email me, go ahead and do it. but no one else s going to see your prose stylings.

SamG

@8
Really? What most people on the left actually think is in line with their traditional suspicion of corporate power (e.g. blaming agrifood business practices) as well as belief that social factors play a role (e.g. why is obesity more prevalent among the poor?). The left’s desired course of action is not to shrug their collective shoulders and say nothing can be done, but that the government should step in and help people achieve better lives. Only a small group of cranks claim obesity is biologically predetermined, and their claim is widely dismissed out of hand.

Sandgroper

Incidentally, it is quite striking in the 2011 CDC data that in the 10 years up to/including 2009/2010, the prevalence of obesity among females in the USA has remained the same, but the prevalence among males has increased. The same % of men are now obese as for women, and a higher % of boys are obese than for girls.

Does anyone understand why that has happened?

April Brown

I’ve noticed a similarity in attitudes from acquaintances who are homophobic and those who are… obesephobic? (Is there a word for that)? Muttering about how it’s a choice, something needs to be done, etc. Online also, when I’ve browsed through comments after a news article about what should be done about fat people making fellow passengers miserable on airplanes, the tone reminds me a lot of the way homosexuality is negatively discussed.

Over in The Altantic Cities blog, there are occasionally articles about obesity as a symptom of poor urban planning. Food deserts, neighborhoods that aren’t walkable, etc. get tied demographically to obesity levels. (Do I have links to these articles? No, no I do not. Shame on me). Would be a nice rebuttal to anybody demanding laws about exercise.

I_Affe

April,

I’m a bit skeptical about food deserts. Anecdotally, I’ve talked to people who live in some areas designated as food deserts, but they still have relatively easy access to smallish markets and produce.

Here’s an article by John McWhoter I found that references several studies on it:

Quote: “being educated or smart also seems to interfere with passing genes. you can look it up in the GSS.”

True, but I think that smart, educated heterosexuals still have a better chance of passing on their genes to the next generation than most homosexuals. Also while the better educated and more intelligent heterosexuals may have a reproductive disadvantage when it comes to making babies in comparison to the less intelligent and less educated, they probably do a better job of raising their children and therefore probably experience lower levels of infant and childhood mortality.

Quote: “is it really obesity? i know this is often claimed, but i’m moderately skeptical. in many poor societies plumpness is preferred. but obesity is considered kind of weird, at least in the young.”

I guess it all depends on what a person means by the word “obesity”. Here is a link to a 2004 BBC News story about the African nation of Mauritania where women are often forced fed because men in that country see heavy women as being more attractive:

#30, the mauritanian example is an excellent positive example of the generalization. but it seems an extreme one.

my point in asking about fitness is that i think the whole idea of passing on genes is overly simplistic. as you yourself acknowledge it when alluding to the quality of offspring. i think homosexuality and obesity are qualitatively different things in any case.

Kris

Yvain elucidates the issue on Lesswrong.

“What is Disease?

In Disguised Queries , Eliezer demonstrates how a word refers to a cluster of objects related upon multiple axes. For example, in a company that sorts red smooth translucent cubes full of vanadium from blue furry opaque eggs full of palladium, you might invent the word “rube” to designate the red cubes, and another “blegg”, to designate the blue eggs. Both words are useful because they “carve reality at the joints” – they refer to two completely separate classes of things which it’s practically useful to keep in separate categories. Calling something a “blegg” is a quick and easy way to describe its color, shape, opacity, texture, and chemical composition. It may be that the odd blegg might be purple rather than blue, but in general the characteristics of a blegg remain sufficiently correlated that “blegg” is a useful word. If they weren’t so correlated – if blue objects were equally likely to be palladium-containing-cubes as vanadium-containing-eggs, then the word “blegg” would be a waste of breath; the characteristics of the object would remain just as mysterious to your partner after you said “blegg” as they were before.

“Disease”, like “blegg”, suggests that certain characteristics always come together. A rough sketch of some of the characteristics we expect in a disease might include:

1. Something caused by the sorts of thing you study in biology: proteins, bacteria, ions, viruses, genes.
2. Something involuntary and completely immune to the operations of free will
3. Something rare; the vast majority of people don’t have it
4. Something unpleasant; when you have it, you want to get rid of it
5. Something discrete; a graph would show two widely separate populations, one with the disease and one without, and not a normal distribution.
6. Something commonly treated with science-y interventions like chemicals and radiation.

Cancer satisfies every one of these criteria, and so we have no qualms whatsoever about classifying it as a disease. It’s a type specimen, the sparrow as opposed to the ostrich. The same is true of heart attack, the flu, diabetes, and many more.

Some conditions satisfy a few of the criteria, but not others. Dwarfism seems to fail (5), and it might get its status as a disease only after studies show that the supposed dwarf falls way out of normal human height variation. Despite the best efforts of transhumanists, it’s hard to convince people that aging is a disease, partly because it fails (3). Calling homosexuality a disease is a poor choice for many reasons, but one of them is certainly (4): it’s not necessarily unpleasant.”

Even though the overweight+obese are a majority, according to leftist discrimination theory, it’s all about power relations. Since the powerful in our society are more likely to be thin, the practice of sizism (discrimination against the fat) is a means by which the powerful oppress the powerless, and is therefore something to be combated with the full force of left-led government.

So just like sexism, the majority can be discriminated against.

ackbark

@33. Yeah, up with blubber! Don’t trust anybody under 300 lbs!

We should have a rally where thousands of regular joe monstrous lardbuckets throw gobs of fat at pictures of scrawny elitists!

Mass consumption is not just a right, it’s an American duty.

http://aman-datta.blogspot.ca/ Aman Datta

I’m offended by this. As a gay man in love with a fat man, this is disturbing.

http://erisianacherie.blogspot.com/ Erisiana Cherie

Hi Razib!

I’ve been a fan for some time but this is the first time I’ve felt like I had anything useful to contribute to the discussion.

Namely: It’s not that there may not be a ‘state a’ and a ‘state b’ that are more/less desirable from an objective health standpoint. It’s that there’s also a ‘state c’ (underweight) that arguably carries MORE severe health consequences, and the combined forces of the diet industry and modern visual media are actually pushing THAT state as the ideal. Moreover, the objective risks of fatness are magnified and imbued with a moral significance and social condemnation that’s not applied to other risky behaviors. (Think of, for instance, NFL football.) The conclusion this suggests to me (and I expect to many folks who’d call themselves “fat acceptance activists”) is that the way obesity is seen & treated has more to do with social dogma than any objective criteria.

I don’t know enough to judge the science news stories that suggest that the recent increase in the number of really fat people around might actually be a result of some not yet understood disease process(es) and therefore not really amenable to the kind of diet-exercise-and-willpower approach that’s been emphasized for decades. But from what I’ve seen the research seems clear and consistent that underweight leads to higher morbidity than overweight OR obese. And yet the generic photo of a smiling woman that accompanies the average weight or nutrition related health news article will almost certainly be of a woman who is, in fact, underweight.

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Gene Expression

This blog is about evolution, genetics, genomics and their interstices. Please beware that comments are aggressively moderated. Uncivil or churlish comments will likely get you banned immediately, so make any contribution count!

About Razib Khan

I have degrees in biology and biochemistry, a passion for genetics, history, and philosophy, and shrimp is my favorite food. In relation to nationality I'm a American Northwesterner, in politics I'm a reactionary, and as for religion I have none (I'm an atheist). If you want to know more, see the links at http://www.razib.com